|
Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator, Male Initial 53600
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
1188975
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.23 |
| Max. Negotiated Rate |
$359.63 |
| Rate for Payer: Aetna Commercial |
$359.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.56
|
| Rate for Payer: Aetna Managed Medicare |
$54.25
|
| Rate for Payer: Anthem Medicare Advantage |
$54.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.25
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$359.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.25
|
| Rate for Payer: Health EOS Commercial |
$344.49
|
| Rate for Payer: HFN Commercial |
$359.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$302.85
|
| Rate for Payer: NAPHCARE Commercial |
$81.37
|
| Rate for Payer: Preferred Network Access Commercial |
$359.63
|
| Rate for Payer: Quartz Beloit One Network |
$166.57
|
| Rate for Payer: Quartz Commercial |
$215.78
|
| Rate for Payer: Quartz Medicare Advantage |
$54.25
|
| Rate for Payer: The Alliance Commercial |
$230.55
|
| Rate for Payer: United Healthcare Medicaid |
$25.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.25
|
| Rate for Payer: WEA Trust Commercial |
$208.21
|
| Rate for Payer: WPS Commercial |
$244.11
|
|
|
Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator; Male Subsequent 53601
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
1188976
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.11 |
| Max. Negotiated Rate |
$324.06 |
| Rate for Payer: Aetna Commercial |
$324.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$46.28
|
| Rate for Payer: Anthem Medicare Advantage |
$46.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.28
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$324.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.28
|
| Rate for Payer: Health EOS Commercial |
$310.42
|
| Rate for Payer: HFN Commercial |
$324.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.28
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$69.42
|
| Rate for Payer: Preferred Network Access Commercial |
$324.06
|
| Rate for Payer: Quartz Beloit One Network |
$150.09
|
| Rate for Payer: Quartz Commercial |
$194.44
|
| Rate for Payer: Quartz Medicare Advantage |
$46.28
|
| Rate for Payer: The Alliance Commercial |
$196.69
|
| Rate for Payer: United Healthcare Medicaid |
$23.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.28
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$208.26
|
|
|
DILATOR 10fr
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
2970839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$75.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.32
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$162.24
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$175.76
|
| Rate for Payer: Quartz Medicare Advantage |
$162.24
|
| Rate for Payer: The Alliance Commercial |
$135.20
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
DILATOR 10fr
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
2970839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.50 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
DILATOR 12-18FR NOTTINGHAM 230-115
|
Facility
|
OP
|
$1,148.00
|
|
| Hospital Charge Code |
2964808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.30 |
| Max. Negotiated Rate |
$1,098.41 |
| Rate for Payer: Aetna Commercial |
$1,074.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,026.77
|
| Rate for Payer: Aetna Managed Medicare |
$334.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$776.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$596.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$573.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$632.78
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$1,098.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$668.14
|
| Rate for Payer: Health EOS Commercial |
$1,062.59
|
| Rate for Payer: HFN Commercial |
$1,098.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$895.44
|
| Rate for Payer: Multiplan Commercial |
$955.14
|
| Rate for Payer: NAPHCARE Commercial |
$716.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,098.41
|
| Rate for Payer: Quartz Beloit One Network |
$585.02
|
| Rate for Payer: Quartz Commercial |
$776.05
|
| Rate for Payer: Quartz Medicare Advantage |
$716.35
|
| Rate for Payer: The Alliance Commercial |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$656.66
|
| Rate for Payer: WPS Commercial |
$884.30
|
|
|
DILATOR 12-18FR NOTTINGHAM 230-115
|
Facility
|
IP
|
$1,148.00
|
|
| Hospital Charge Code |
2964808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$585.02 |
| Max. Negotiated Rate |
$1,098.41 |
| Rate for Payer: Aetna Commercial |
$1,074.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,026.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$632.78
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$1,098.41
|
| Rate for Payer: Health EOS Commercial |
$1,062.59
|
| Rate for Payer: HFN Commercial |
$1,098.41
|
| Rate for Payer: Multiplan Commercial |
$955.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,098.41
|
| Rate for Payer: Quartz Beloit One Network |
$585.02
|
| Rate for Payer: Quartz Commercial |
$716.35
|
| Rate for Payer: WEA Trust Commercial |
$656.66
|
| Rate for Payer: WPS Commercial |
$884.30
|
|
|
DILATOR 12fr
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
2970840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.50 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
DILATOR 12fr
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
2970840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$75.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.32
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$162.24
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$175.76
|
| Rate for Payer: Quartz Medicare Advantage |
$162.24
|
| Rate for Payer: The Alliance Commercial |
$135.20
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
DILATOR 19mm 57fr 70cm
|
Facility
|
OP
|
$3,171.00
|
|
| Hospital Charge Code |
2973327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$923.40 |
| Max. Negotiated Rate |
$3,034.01 |
| Rate for Payer: Aetna Commercial |
$2,968.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,836.14
|
| Rate for Payer: Aetna Managed Medicare |
$923.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,143.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,648.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,582.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.86
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$3,034.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,845.52
|
| Rate for Payer: Health EOS Commercial |
$2,935.08
|
| Rate for Payer: HFN Commercial |
$3,034.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,473.38
|
| Rate for Payer: Multiplan Commercial |
$2,638.27
|
| Rate for Payer: NAPHCARE Commercial |
$1,978.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.94
|
| Rate for Payer: Quartz Commercial |
$2,143.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,978.70
|
| Rate for Payer: The Alliance Commercial |
$1,648.92
|
| Rate for Payer: WEA Trust Commercial |
$1,813.81
|
| Rate for Payer: WPS Commercial |
$2,442.62
|
|
|
DILATOR 19mm 57fr 70cm
|
Facility
|
IP
|
$3,171.00
|
|
| Hospital Charge Code |
2973327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,615.94 |
| Max. Negotiated Rate |
$3,034.01 |
| Rate for Payer: Aetna Commercial |
$2,968.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,836.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.86
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$3,034.01
|
| Rate for Payer: Health EOS Commercial |
$2,935.08
|
| Rate for Payer: HFN Commercial |
$3,034.01
|
| Rate for Payer: Multiplan Commercial |
$2,638.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.94
|
| Rate for Payer: Quartz Commercial |
$1,978.70
|
| Rate for Payer: WEA Trust Commercial |
$1,813.81
|
| Rate for Payer: WPS Commercial |
$2,442.62
|
|
|
DILATOR 4fr MERIT
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
2971699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
DILATOR 4fr MERIT
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2971699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
DILATOR 5fr MERIT
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2971700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
DILATOR 5fr MERIT
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
2971700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
DILATOR 6-12FR NOTTINGHAM 230-101
|
Facility
|
OP
|
$1,826.00
|
|
| Hospital Charge Code |
2964809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.73 |
| Max. Negotiated Rate |
$1,747.12 |
| Rate for Payer: Aetna Commercial |
$1,709.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,633.17
|
| Rate for Payer: Aetna Managed Medicare |
$531.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,234.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$949.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$911.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,006.49
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna Commercial |
$1,747.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,062.73
|
| Rate for Payer: Health EOS Commercial |
$1,690.15
|
| Rate for Payer: HFN Commercial |
$1,747.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,424.28
|
| Rate for Payer: Multiplan Commercial |
$1,519.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,139.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,747.12
|
| Rate for Payer: Quartz Beloit One Network |
$930.53
|
| Rate for Payer: Quartz Commercial |
$1,234.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,139.42
|
| Rate for Payer: The Alliance Commercial |
$949.52
|
| Rate for Payer: WEA Trust Commercial |
$1,044.47
|
| Rate for Payer: WPS Commercial |
$1,406.57
|
|
|
DILATOR 6-12FR NOTTINGHAM 230-101
|
Facility
|
IP
|
$1,826.00
|
|
| Hospital Charge Code |
2964809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$930.53 |
| Max. Negotiated Rate |
$1,747.12 |
| Rate for Payer: Aetna Commercial |
$1,709.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,633.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,006.49
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna Commercial |
$1,747.12
|
| Rate for Payer: Health EOS Commercial |
$1,690.15
|
| Rate for Payer: HFN Commercial |
$1,747.12
|
| Rate for Payer: Multiplan Commercial |
$1,519.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,747.12
|
| Rate for Payer: Quartz Beloit One Network |
$930.53
|
| Rate for Payer: Quartz Commercial |
$1,139.42
|
| Rate for Payer: WEA Trust Commercial |
$1,044.47
|
| Rate for Payer: WPS Commercial |
$1,406.57
|
|
|
DILATOR 6FR
|
Facility
|
IP
|
$163.00
|
|
| Hospital Charge Code |
2970585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$101.71
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
DILATOR 6FR
|
Facility
|
OP
|
$163.00
|
|
| Hospital Charge Code |
2970585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.47 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$47.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.87
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.14
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$101.71
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$110.19
|
| Rate for Payer: Quartz Medicare Advantage |
$101.71
|
| Rate for Payer: The Alliance Commercial |
$84.76
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
DILATOR 6fr MERIT
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2971701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
DILATOR 6fr MERIT
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
2971701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
DILATOR 7FR
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
2970842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.50 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
DILATOR 7FR
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
2970842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$75.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.32
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$162.24
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$175.76
|
| Rate for Payer: Quartz Medicare Advantage |
$162.24
|
| Rate for Payer: The Alliance Commercial |
$135.20
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
DILATOR 7fr #OBT-7FR-11
|
Facility
|
IP
|
$258.00
|
|
| Hospital Charge Code |
2969093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
DILATOR 7fr #OBT-7FR-11
|
Facility
|
OP
|
$258.00
|
|
| Hospital Charge Code |
2969093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.16
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.24
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$160.99
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$174.41
|
| Rate for Payer: Quartz Medicare Advantage |
$160.99
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
DILATOR 9fr
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
2970838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$75.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.32
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$162.24
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$175.76
|
| Rate for Payer: Quartz Medicare Advantage |
$162.24
|
| Rate for Payer: The Alliance Commercial |
$135.20
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
